ObjectiveTo review the advances in the diagnosis and treatment of obstetric brachial plexus palsy (OBPP). MethodsThe incidence, risk factors, classification, and imaging tests of OBPP and indication, technique, and results of surgery were reviewed and summarized. ResultsThe incidence of OBPP is not declining in recent years. Birth weight of ≥4 kg, forceps delivery, and prepregnancy body mass index of ≥21 are considered to be major risk factors, and caesarean section delivery seems to be a protective factor. Neurophysiological investigations can be applied to qualitative diagnosis of OBPP, but can not to quantitative one. Sensitivity and specificity of both CT and MRI myelography are about 0.7 and 0.97, respectively. Narakas classification is widely used:C5, 6 injury as type I, C5-7 injury as type Ⅱ, C5-T1 injury as type Ⅲ, C5-T1 injury with Horner's syndrome as type IV. It is generally considered that the brachial plexus exploration should be undertaken for infants without spontaneous recovery of elbow flexion by a maximum of 3 months old; and 10% to 30% of patients may need nerve reconstruction surgery. It is advocated that traumatic neuroma of the upper trunk should be resected with nerve reconstruction. The final evaluation for surgical results should be at minimal 4 years for upper roots and 8 years for total roots. Scales of Mallet, Gilbert, and Raimondi are mostly used for assessing shoulder function, elbow function, and hand function. ConclusionBrachial plexus exploration should be undertaken for infants without flexion of elbow at the age of 3 months. Traumatic neuroma (even neuroma-in-continuity) resection followed by microsurgical reconstruction of the brachial plexus is favored.
Mitral regurgitation (MR) is the most common type of valvular heart disease. Mitral valve repair/replacement can improve the prognosis of patients with severe MR, but a large proportion of patients cannot tolerate surgical procedures due to comorbidities and surgical risks. Transcatheter mitral valve replacement (TMVR) is a kind of treatment for mitral valve disease in which an artificial valve is delivered to the mitral valve annulus through a catheter and released into place, with the advantages of no thorax opening, less trauma and high safety. Early clinical studies of TMVR have shown good results, but still face many challenges. Strict indications are effective measures to reduce surgical risks and postoperative complications. This article explores the relevant indications of TMVR by analyzing several studies at home and abroad.
ObjectiveTo explore the vascular conditions and the necessity of vascular reconstruction in the treatment of chronic ischemic diseases of lower extremities with tibial transverse transport (TTT) from the perspective of vascular surgery.MethodsA clinical data of 59 patients with chronic ischemic disease of lower extremities treated by TTT between February 2014 and July 2019 were analyzed retrospectively. Among them, there were 41 patients with diabetic foot (DF), including Wagner grade 3-4, Texas grade 2-3, and stage B-D lesions; the disease duration ranged from 0.7 to 2.4 years, with an average of 1.5 years, and 5 cases complicated with arteriosclerosis obliteran (ASO). There were 14 patients with ASO (Fontaine stage Ⅳ and Rutherford stage Ⅲ-Ⅳ) with an average disease duration of 10.8 months (range, 1.5-23.4 months). There were 4 patients with thromboangiitis obliteran (TAO) with an average disease duration of 12.3 months (range, 2.1-18.2 months), and the clinical stages were all in the third stage. In 18 patients that ankle brachial index (ABI) of anterior or posterior tibial artery was less than 0.6 before operation, or the blood flow of the three branches of inferior anterior tibial artery did not reach the ankle by imaging examination, vascular reconstruction was performed before TTT (5 cases of DF combined with ASO, 12 of ASO, 1 of TAO). After operation, the effectiveness was evaluated by ulcer wound healing, skin temperature, pain visual analogue scale (VAS) score, ABI, and CT angiography (CTA) examination.ResultsThe patients with DF were followed up 8-16 months (mean, 12.2 months); the ulcer wounds healed with a healing time of 5.1-9.2 weeks (mean, 6.8 weeks); CTA examination showed that the branches of inferior anterior tibial artery were opened in 5 patients after revascularization; and the tibial osteotomy healed for 5-14 weeks (mean, 8.3 weeks). The patients with ASO were followed up 13-25 months (mean, 16.8 months); the ulcer wounds healed with a healing time of 6.2-9.7 weeks (mean, 7.4 weeks). CTA examination showed that the branches of inferior anterior tibial artery were opened in 12 patients after revascularization; all tibial osteotomy healed, and the healing time was 4.5-14.4 weeks (mean, 10.2 weeks). The patients with TAO were followed up 12-23 months with an average of 12.3 months, and toe/limb amputation was performed after ineffective treatment. The patients were divided into two groups according to whether they were combined with revascularization or not. The ABI, VAS score, and skin temperature in the combined revascularization group significantly improved at 6 months after operation (P<0.05); while there was no significant difference in ABI at 6 months after operation in the TTT group (P>0.05), but the skin temperature and VAS scores significantly improved when compared with those before operation (P<0.05).ConclusionThe ABI of anterior or posterior tibial artery is more than 0.6, radiological examination shows that at least one of the three branches of inferior anterior tibial artery leads to ankle artery, which is a prerequisite for successful TTT in the treatment of chronic ischemic disease of lower extremities. DF is the indication of TTT. ASO can choose TTT, and TAO should use this technique cautiously.
Obesity is a disease state characterized by the accumulation of abnormal or excessive fat that threatens human health. With the rapid development of the economy and society and the change in lifestyle, obesity is highly prevalent in our country and has become an important disease that threatens the health of the population. Different from traditional non-surgical treatments, metabolic and bariatric surgery has a definite curative effect, is not easy to rebound, has good safety, and has sufficient evidence of clinical benefit, which can make many obese patients, especially those with moderate to severe obesity, fully recover. The treatment of obesity has become an important means in the comprehensive treatment of obesity. This article intends to describe the application of bariatric metabolic surgery in the comprehensive treatment of obesity from three aspects: bariatric surgery indications, surgical method selection, and perioperative multidisciplinary intervention.
Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.
Current guidelines recommend follow-up observation for moderate aortic stenosis (MAS), but clinical evidence shows that its prognosis is poor, especially when combined with left ventricular systolic dysfunction, the risk of death and hospitalization for heart failure is significantly increased. With the technical maturity and device development of transcatheter aortic valve replacement (TAVR), its therapeutic potential in MAS has attracted attention. This paper systematically reviewes the risk stratification indicators of MAS and the clinical research results of early TAVR intervention, and analyzes the key clinical issues such as patient selection and operation timing. It points out that early TAVR may improve the prognosis and quality of life of some high-risk MAS patients, but its wide clinical application still needs more evidence-based medical evidence support.
Abstract： Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.
Objective To introduce summarily and discuss current controversial problems in terms of necessity and methods of preoperative biliary drainage for patients with malignant biliary obstruction diseases. Method The relevant domestic and international literatures in recent years were reviewed and summarized, and the basis, pros and cons, selectable ways, and current controversy of preoperative biliary drainage were analyzed. Results With development of the research, the view of preoperative biliary drainage also has been changed continuously. At the present time, the main arguments focus on the necessity, timing, biliary decompression way of preoperative biliary drainage and corresponding surgical opportunity after biliary drainage. Incorrect patient selection and undue pursuit of preoperative biliary drainage would be completely opposite to the treatment of malignant biliary obstruction. Conclusions It is generally recommended that preoperative biliary drainage in patients with malignant biliary obstruction diseases is not needed and surgery is performed directly. For patients who have indications of preoperative biliary drainage, it could make patients spend perioperative period smoothly if a reasonable way of biliary decompression is chosen. However, it is necessary to take some large sample retrospective analyses or prospective studies for exploring existing problems of preoperative biliary drainage in future.
Objective To investigate the knowledge level of Chinese cardiac surgeons regarding the management of infective endocarditis (IE), in order to identify the gap between clinical practices and the latest guidelines, and provide evidence-based support for improving the clinical management of IE. Methods A nationwide survey was conducted through an online questionnaire from December 5, 2024, to December 31, 2024. Descriptive analysis of the survey data was performed. Results A total of 67 valid responses were received from 18 provincial-level administrative divisions across China. While 56.7% (38/67) of respondents demonstrated familiarity with the modified Duke criteria, only 43.3% (29/67) comprehended the 2023 Duke- International Society of Cardiovascular Infectious Diseases criteria. Conversely, 43.3% (29/67) exhibited limited understanding of the former, and 56.7% (38/67) showed deficient knowledge of the latter diagnostic standards. Only 46.3% (31/67) reported proficiency in current IE management guidelines/consensus. Regarding surgical timing, 26.9% (18/67) advocated intervention within 7-14 days of antimicrobial therapy, 22.4% (15/67) during 14-28 days, and 10.5% (7/67) beyond 28 days. Notably, a significant proportion of respondents opted for delayed surgical intervention beyond guideline recommendations when managing patients with heart failure, uncontrolled infection, or neurological complications. Conclusion A knowledge gap and practice discrepancies exist among Chinese surgeons regarding the management of IE. There is an urgent need to promote updated concepts regarding surgical indications and timing for IE in order to optimize treatment strategies and improve patient prognosis.
ObjectiveTo review the research progress of indication and treatment of graft in shoulder superior capsular reconstruction (SCR) for rotator cuff tear (RCT).MethodsThe literature related to shoulder SCR in recent years was extensively reviewed, and the anatomy, biomechanics, surgical indications, and treatment of graft in SCR were summarized.ResultsSuperior capsule plays a role as a functional complex with rotator cuff, ligament, and whole capsule. SCR can effectively restore the superior stability of the shoulder. The indications of SCR include the irreparable massive RCT, massive RCT combined with pseudoparalysis shoulder, medium/large RCT with severe degenerative rotator cuff tissue, and dual-layer RCT. In order to achieve a better healing of tendon-bone in graft and decrease the rate of long-term graft retearing, it is essential to select an appropriate thickness graft, fix the graft in right intensity, and get a better capsular continuity.ConclusionThe technique of SCR advanced to SCR for reinforcement and it is indicated from substantial massive RCT to severe degeneration of rotator cuff tissue. Graft treatment is the key step for a successful SCR.